Is Donald Truly Delusional?

A recent article in US News relates how John Gartner, a psychotherapist at Johns Hopkins University and author of a biography of Bill Clinton, has stated that our new president, Donald Trump, suffers from a psychiatric condition called Malignant Narcissism.[i] Though he realizes that he is breaking to so-called Goldwater rule, which recommends that a physician should not diagnose a patient without interviewing him, Gartner is so concerned that he sidesteps the rule and is quoted as saying, "Donald Trump is dangerously mentally ill and temperamentally incapable of being president." The symptoms of Malignant Narcissism that Mr. Trump purportedly manifests are many and include antisocial behaviors, sadism, lack of conscience, and manipulative and aggressive tendencies.

When I read the article closely, I too saw firm grounds to entertain such a diagnosis, and yet I decided to push the matter further. As an active member of the American Psychiatric Association (APA), I take the Goldwater rule seriously, but I think it reasonable to create further hypotheses about such a powerful public person who makes so many startling and often preposterous statements and draws factually unsupportable conclusions. Further, after poring over the recent interview of Trump by John Muir of ABC news and reading the transcript,[ii] I grew even more concerned that our new president may warrant another psychiatric diagnosis, one more severe.

Donald Trump may suffer from a delusional condition, with both paranoid and grandiose features. Such a condition suggests breaks with reality. Such a dyad of conditions—delusions and malignant narcissism—most likely plagued both Adolf Hitler and Joseph Stalin. So if my hypothesis is correct, then these conditions will impact disastrously on Mr. Trump’s capacity to serve as leader of the Free World.

Though my hypothesis may seem surprising, let me explain how I reached this alarming, if provisional conclusion. When a psychiatrist first interviews a patient, he or she uses a simple format referred to as a Mental Status Examination, which consists of the physician posing a number of set questions usually in a calm and caring manner to the patient so he or she can speak freely. When I watched the interview by David Muir of Mr. Trump, I felt as though I had wandered into such a mental status interview, with Mr. Muir serving as psychiatrist, myself as a senior peer sitting beside him, and Mr. Trump as the patient.

The interview begins with Muir and Trump walking toward the interview room as Muir asks whether the President anticipates changing, now that he is in office. Donald states no and then rather boastfully continues: “I can be the most presidential person ever, other than possibly the great Abraham Lincoln. But I might not be able to do the job as well if I do that.”

Already I grew astonished at what I’d heard since it suggested such a significant degree of grandiosity in Trump. Either he manifested boastful posturing or he was out of touch with reality. With the two shortly settled in their chairs, the interview proper begins.

Following the format of a Mental Status Exam, I noted that Trump is alert and oriented to person, time and place in that he knows who he is, that he is five days into his presidency and is in the White House. His mood moves between calm and intense, sometimes even slightly irritated with Muir. At one moment he belittles Muir by pointing out how ABC’s rating are at only 17 percent. His affect is neither fluctuating nor blunted. Throughout the interview he sits forward in his chair, often splaying his fingers out to make his points. This seems to happen more often when he finds that Muir is skeptical of what he says. His speech is rapid at time and usually comprehensible, although at times he speaks in half and garbled sentences. For instance, when discussing the Wall, he says: “Lots of things are coming across Mexico that they don’t want. I think it’s going to be a good thing for both countries. And I think the relationship will be better than ever before.” And later when discussing renegotiating NAFTA he says, “We have a $60 million trade deficit. So if you want, I can wait two years and then we can do it nice and easily. I want to build the Wall immediately.” Though these sentences can be untangled, it takes a significant amount of effort on the part of the listener.

Much of the Mental Status Examination involves testing cognitive functioning through the physician posing set questions. These tests are meant to assess concentration, math skills, memory, and logical and abstracting abilities. Of course Muir does not ask such questions directly, but we can glean much about Mr. Trump’s capacities in these areas through the questions Muir does ask and Mr. Trump’s responses. For instance, when asked about how payment would be made for the Wall, Trump sidesteps any details and fudges the math regarding payments. Money seems to mysteriously appear. With regards to thinking logically and abstractly, Trump often manifests significant problems. For instance, when Mr. Trump insists that 3 to 5 million voters illegally voted and Mr. Muir points out that this is unlikely and that even leaders in his own party disagree, Trump seems to ignore the math and Muir’s attempt to ground him in reality. Rather he perseverates on his idea and then conflates this issue with another, namely the belief that, if he had campaigned more heavily in states like California and New York where he lost by large margins, he could have won the popular vote. Returning to the phantom droves of fraudulent voters, he is convinced that none of them voted for him but rather for Hillary. In short, he manifests both illogical thinking and disorganization of thought all while discussing one topic. When Mr. Muir persists in pushing back, Mr. Trump grows more emphatic. Splaying out his fingers, he brings up the Pew report to buttress the argument that voter fraud is rampant. Mr. Muir explains that he had spoken with its author the evening before and that the author stated that his study does not demonstrate widespread voter fraud at all. Mr. Trump now grows irritated with Muir and states that the author, who Mr. Trump calls “the reporter,” has changed his story and must be groveling. Never does he ask Muir to expand on the details of his discussion with the Pew author but rather doubles down on his belief that voter fraud is widespread, a clear instance of the other side cheating and media setting out to demean him. In short, Mr. Trump manifests problems with simple math and logical and abstracting abilities.

During a portion of a standard Mental Status Examination, the psychiatrist often focuses on the patient’s personal history. In the Trump interview, Mr. Muir instead poses a series of questions to Mr. Trump regarding controversies into which Mr. Trump has become embroiled in his first week in office. We psychiatrists would call this material the content of the interview, and from this material certain themes often emerge. On the topics discussed, including the crowd size at the inauguration, the number of supposed fraudulent votes cast in the election, the efficacy of torture by the CIA in the war on terror, the subject of removing Iraqi oil, and the horrors of Obamacare, Mr. Trump manifested ideas and beliefs that seemed not simply startling, but out of touch with the actual facts. For instance, regardless of what the data seem to suggest, Mr. Trump remains adamant that his inaugural crowd size was bigger than Obama’s. He insisted not only that 3 to 5 million fraudulent votes were cast, despite offering no proof, but he also insists that all these votes were cast for Hillary, not for him. In terms of torture, and he uses this very word, he insists that it is effective since a few people have told him so, despite the bulk of the evidence that I can gather contradicting this position[iii]. Also, he disputes that torture is against international law. In terms of Iraq oil, his argument grows convoluted, and he even leaves open the idea that he might reinvade Iraq for the sake of the oil. We should have extracted all the oil during the invasion despite the obvious fact that the oil would take years to extract and that such extraction would violate international treaties. What drives his argument is that without the oil, ISIS would not be able to fund itself.

In short, as a psychiatrist mulling over these matters, by interview’s end, I strongly wondered whether Mr. Trump might truly suffer from what we in my profession call delusions.

Dr. George Drinka is a child and adolescent psychiatrist and the author of The Birth of Neurosis: Myth, Malady and the Victorians (Simon & Schuster). His new book, When the Media Is the Parent, is a culmination of his work with children, his scholarly study of works on the media and American cultural history, and his dedication to writing stories that reveal the humanity in us all.

Are you saying that President Trump has a chemical imbalance? Is the etiology of your diagnosis problems in childhood or genetics. Would you recommend cognitive behavior therapy, psychoanalysis, or possibly psychotropics. What you are calling pathological symptoms may have many different origins. Frequently we say the individual lacks insight as to the cause or even that the behavior in question is pathological. Sometimes these behaviors can be used for attention and even to gain support. People making these sort of arm chair diagnosis need to have more of an open mind and less narrow minded jumping to conclusion. Or maybe some self reflection is called for. Possibly projecting their own pathology onto another person.

Great stuff. Now do Obama. Of course you won't. How about FDR, the only president in modern history who actually put Americans in concentration camps. LBJ? Just kidding. You are pathologizing political disagreement. He is a narcissist? No kidding. Thin skinned? No question about it. Average people don't run for President. But this game of pretending he is mentally ill and comparing him to two men who killed millions of people tells us more about the author of this piece than it does about the subject.

And will you do Jesus? Anybody claiming they're the son of God would immediately get "diagnosed" and his assertion would be rejected out of hand. This whole discussion gets kind of silly because when it comes to this kind of psychology, it's not purely objective, but also necessarily includes a big dose of subjective and unproven "truths" and concepts of "good" and "desirable" social behavior which CANNOT be derived from science.